Chapter 122 - Peritonitis

Question 1

What is the postulated mechanism for primary peritonitis?

Answer 1

Hematogenous dissemination of infectious agents

Likely facilitated by impaired host immune defenses

Question 2

If a cat is diagnosed with primary peritonitis with Bacteroides and Fusobacterium spp., what is the likely source?

Answer 2

Translocation from the oral cavity (unrecognized direct

penetration (bites) or a hematogenous route)

Question 3

What is the most common cause of secondary peritonitis?

Answer 3

Contamination from the GI tract (ulceration, foreign body obstruction, neoplasia, trauma, ischemic damage, or dehiscence of a previous surgical incision.)

Question 4

Below which serum albumin concentration hypoalbuminemia becomes a risk factor for septic peritonitis after GI surgery?

Answer 4

< 2.5 g/dL

Question 5

T/F: tachycardia and hypothermia are negative prognostic factors in cats with septic abdomen

Answer 5

F: bradycardia and hypothermia

Question 6

How does the concurrent presence of pleural effusion affect the prognosis of peritonitis?

Answer 6

The presence of bicavitary effusion increased the mortality rate of patients 3.3-fold compared with that of patients with peritoneal effusions alone

Question 7

What differences between glucose and lactate serum concentration and peritoneal concentration are suggestive of bacterial peritonitis?

Answer 7

Glucose: difference of > 20 mg/dL
Lactate: difference of > 2 mmol/L

Question 8

In which situations, differences between glucose and lactate serum concentration and peritoneal concentration are unreliable to diagnose a septic peritonitis?

Answer 8

• In case of hemoabdomen
• In case of dextrose administration
• Postoperative cases in which closed suction drains have been placed

Question 9

What ratios of peritoneal:serum concentration of potassium and creatinine are suggestive of a uroabdomen?

Answer 9

• Peritoneal:serum creatinine more than 2 : 1

- Peritoneal:serum potassium concentration more than 1.4 : 1

Question 10

What are common bacteria isolated from a septic abdomen?

Answer 10

Escherichia coli, Clostridium spp., and Enterococcus spp. are common isolates.

Question 11

What suture material is advocated in animals with septic abdomen?

Answer 11

Monofilament resorbable

Question 12

Why is it recommended to preserve as much omentum as possible for the surgical treatment of a septic abdomen?

Answer 12

• To promote venous and lymphatic drainage from the peritoneal cavity.
• Immunogenic, angiogenic, and adhesive properties.

Question 13

What are the risks of an open abdominal drainage of peritonitis?

Answer 13

• Susceptibility to superinfection with nosocomial bacteria

- Massive fluid and protein losses

Question 14

Is the vacuum-assisted peritoneal drainage placed over the cranial or caudal aspect of the abdominal incision?

Answer 14

Cranial (1/3 to 2/3)

Question 15

What are poor prognostic factors for animals with septic abdomen?

Answer 15

• Refractory hypotension, cardiovascular collapse, disseminated intravascular coagulation, and respiratory disease
• The combination of hypothermia and bradycardia in cats

Question 16

Define peritonitis.

Answer 16

Inflammation of the peritoneal cavity, classified by underlying cause (primary vs secondary), extent (local or generalized) or presence of infectious agents (septic vs non-septic)

Question 17

What is primary peritonitis?

Answer 17

Spontaneous inflammatory condition in the absence of underlying intra-abdominal pathology or known history of penetrating peritoneal injury

Question 18

What is one proposed mechanism of primary peritonitis?

Answer 18

Hematogenous dissemination

Question 19

Common example of primary peritonitis?

Answer 19

FIP, Salmonella typhirium, Clamydia pssitaci, Clostridium limosum, Mesocestoides spp, Candida, Bacteroides, Actinomyces, Blasto

Question 20

T/F: Secondary peritonitis is usually identified as a septic cause.

Answer 20

True

Question 21

What was found to be the underlying pathology in 25% of cats with septic peritonitis secondary to GI leakage?

Answer 21

Neoplasia (lymphoma and adenocarcinoma)

Question 22

What conditions increased the risk for leakage after intestinal anastamosis in dog?

Answer 22

Perioperative peritonitis, intestinal FB, serum albumin <2.5 (also intra-op hypotension)

Question 23

T/F: Bradycardia and hypothermia in cats with primary septic peritonitis has been established as a negative prognostic indicator.

Answer 23

True

Question 24

When does dehisence typically occur after surgery?

Answer 24

3-5d

Question 25

What should be performed when peritonitis is suspected despite the absence of detectable effusion or when a minimal volume of effusion makes it difficult to obtain a sample?

Answer 25

Diagnostic peritoneal lavage (Catheter into abdomen, infusion of 22ml/kg warm sterile isotonic saline and then getting a sample for analysis, C/S)

Question 26

A concentration of what between paired samples for blood and peritoneal glucose is a reliable predictor of a bacterial peritonitis.

Answer 26

20mg/dL

Question 27

T/F Abdominal fluid lactate concentration of greater than 2.0mmol/L is predictive of septic peritonitis in a patient with a closed suction drain.

Answer 27

False, less than 2.0mmol/L

Question 28

Diagnosis of a uroperitoneum can be made if the peritoneal fluid creatinine or K concentration exceeds that of the serum by what?

Answer 28

Creatinine 2:1

K 1.4:1

Question 29

T/F: Placement of nonabsorbable suture material can be used within the abdominal cavity with septic peritonitis.

Answer 29

False, can serve as a nidus for infection

Question 30

T/F: If debridement and lavage can resolve gross foreign material or GI spillage and the source of contamination can be controlled, the abdomen should be closed primarily.

Answer 30

True

Question 31

What is the goal of blood component therapy in stabilizing patients with peritonitis (PCV, serum protein, COP)?

Answer 31

PCV >20-25%, serum protein >3.5g/dL, COP >16 mmHg

Question 32

What are some poor prognostic indicators for patients with septic peritonitis?

Answer 32

Refractory hypotension, cardiovascular collapse, DIC and respiratory disease